Knee Claim

[tom91]

Okey, I'm confused. The VA denied my claim to increase my knee disability from 10%. I originally received the percentage with the diagnosis 'patellofemoral chondromalacia' and that is also the diagnosis this time. They are using code 5260 - Leg flexion limited to 45%o. In reading the medical terms for this diagnosis, I'm confused as to why they would not use 5258 - Cartilage, semilunar, dislocated, with frequent episodes of locking, pain and effusion into the joint. Below is a definition of the diagnosis: When the knee moves, the kneecap (patella) slides to remain in contact with the lower end of the thigh bone (trochlear groove of the femur). Normally, this motion has almost no friction: the friction between these two joint surfaces is approximately 20% the friction of ice sliding against ice. If the patella and /or femur joint surface (articular cartilage) becomes softened or irregular, the friction increases. Grinding or crepitus that can be heard or felt when the knee moves is the result. This condition in which there is patellofemoral crepitus is called chondromalacia patella or patellofemoral syndrome.

The examiner reported that I had crepitus, tenderness, painful movement but no sign of clicks/snaps, grinding, instability, patellar abnorms, or meniscus abnorms. Not sure how she came up with that as everytime I move it, I FEEL the grinding and hear the snaps! My ortho exam and MRI findings stated I had fraying of lateral meniscus, osteoarth, and small joint effusion.

Now, am I off on left field thinking it should have been rated under a different code?

[carlie]

tom91,

I feel that many times VA rates disabilities under an inaccurate diagnostic code

which can result in an improper percentage of disability being granted.

My knowledge on bones and joints is fairly limited, but we have several members

that are very familiar with your issues.

Hopefully Rentalguy1 will pick up on this thread and shed some light for you.

Hang on a bit and others will chime in.

carlie

[rentalguy1]

The code you are under is acceptable, and I actually wish they had me under that instead of 5257. The code that you have in mind (5258) actually has nothing to do with your condition. That code would be used for a torn meniscus, or something similiar. Chondromalacia is arthritis within one or more compartments of the knee. It is also called "runner's knee." Typically, about 10% each is all we can ever expect to get. I've tried five times to get an increase, and five times I've been denied.

[Mcafee]

Hello All Hope All Is Well. I have a question in your AWARD letter what does it exactly state in Re: this condition?

[tom91]

It states -

We have continued 10% for patellofemoral chondromalacia, right knee. Records dated xx show complaints of rt knee pain/sprain...treated/released. VA exam (for claim review) shows range of motion from 0 to 115 degrees flexion, with pain @110 degrees, extension from 0 to 0 degrees, with no addt'l loss of motion on repetitive use. Examiner notes you have crepitus, tenderness, painful movement, and guarding of movement, with no evidence of clicks or snaps, grinding, instability, patellar abnormality, or meniscus abnormality. Examiner reports MRI done at XX dated xx reveals myxoid degeneration of the medial meniscus, degenerative fraying of free edge of lateral meniscus, with minimal tricompartmental osteoarthritic changes and small joint effusion. Examiner provides diagnosis of patellofemoral chondromalacia, rt knee. Based on evidence, 10% is continued. A higher evaluation of 20% not warranted unless there is limited range of motion to 30 degrees flexion, or 15 degrees extension.

One additional comment on this claim. The examiner literally forced my leg back to the extent it brought tears because it was so painful and measured it at that point. Didn't matter I gasped in pain and asked that she stop.

[Mcafee]

Hello All Hope All Is Well.Tom you should have recieved a letter from your VARO Veterans Administration Regional Office.From when you initially applied for service connection conditions,Then they sent you for an examination or a C+P EXAM,thenVARO made a decision as to the extent of this condition and put it into word such as a musculolskelatel condition?I also highly recommend you take all of your medical history and go for a new evaluation outside of the VA for this opinion.and if you can get several examsjust provide the documents to the physician and when they ask you a question answer them to the best of your knowledge.but be clear to the physician ahead of timer so you dont waist your time that you are looking for anon bias opinion.many physicians do not like to refute others.espicially VA I still haven't figure that out but i guess if you irritate the Government enough well enough said. I hope this helps my Friend.But there has toi be a Letter from VARO to Label this condition not the results opinions vary.Good Day